Survival of the Richest

The mothers of Southeast D.C. have more in common than we’d like to think with mothers in the mud huts of Dhaka, Bangladesh, or the slums of Nairobi, Kenya. Worldwide, our poorest urban mothers face a harsh reality: When it comes to their children’s well-being, it’s survival of the richest.

Reviewing urban data in more than 50 developing countries, Save the Children’s annual State of the World’s Mothers report, published Tuesday, has concluded that, in most countries, the poorest children living in urban areas are at least twice as likely to die before their fifth birthday as the richest children. In some countries, the odds are three to five times higher. The phenomenon is what we call the “urban disadvantage.”

The report found huge disparities in survival rates between rich and poor children in Washington, D.C. In 2012, babies in the city’s poorest section were more than 10 times as likely to die in their first year of life as babies in the city’s wealthiest section. The poorest babies in many cities throughout the United States face similar challenges in surviving their first year of life.

What’s causing these higher death rates in low-income neighborhoods of the nation’s capital? There is no simple answer, but health experts point to the enormous amount of stress that many mothers in low-income areas encounter as they struggle to keep their families intact with few resources and reduced access to quality health care.

To be sure, life for mothers and their babies struggling with poverty in the U.S. can be enormously challenging, but it pales in comparison to the truly horrible living conditions in slums in developing countries. Families often live in shacks, sleeping several to a room on a mud floor, without blankets to keep them warm. In squatter settlements, mothers live in constant fear of eviction and sexual assault. Health care is often non-existent. Waterborne diseases like cholera can race through a settlement like wildfire.

In the slums of Dhaka, Joynab is typical of most mothers nearby. She lost two of her six children shortly after childbirth, due in part to the babies’ serious breathing problems. She has never had access to medical care during her pregnancies — not even the routine immunizations and nutritional supplements many expectant mothers receive.

Joynab’s surviving children are malnourished, and she is especially worried about her 8-month-old son, Ashim. He weighs less than 9 pounds and “is getting lean and thin day by day,” she says. “I can’t give him enough breast milk.”

Despite this bleak outlook, recent trends show an increasing number of young women moving to cities on their own; often, they are the principal wage earners for themselves and their families. Many of these women — some just teenage girls — are seeking economic opportunities or fleeing discrimination, hoping for a better life in the city. And the trend is accelerating. Today, one-third of urban residents in developing countries — more than 860 million people — live in slums, and the number could reach a billion by 2020.

All of this is happening while many developing nations are celebrating their progress in saving the lives of mothers and children. The global number of child deaths has been cut in half since 1990, from almost 35,000 deaths per day to about 17,000 deaths per day.

But beneath remarkable improvements in national averages hides a harrowing reality for the poorest mothers and children. Our report found that inequality is worsening in far too many places. More than 6 million children a year don’t live to celebrate their fifth birthday — a figure that includes a million newborns who die every year on the day they are born, mostly from causes we know how to address.

Our analysis found that declining national or citywide death rates often mask much higher mortality rates among children living in the poorest urban areas. That’s the case in Washington, which has cut its infant mortality rate in half in the past 15 years even as death rates in the city’s poorest sections remain stubbornly high.

On the positive side, we found compelling success stories in seemingly unlikely places: Cairo has almost doubled the pace of progress in recent years, reducing child mortality rates by more than half since 2000, with evidence indicating the benefits are being shared across all income groups. In fact, child survival rates for the poorest urban children in Egypt have improved more than for the most affluent children. Cities such as Addis Ababa in Ethiopia and Manila in the Philippines have shown similar progress in helping the poorest children survive. In both of these countries, the poorest urban children have made by far the most progress.

It’s worth remembering this week, as many of us scramble to get our wives and mothers appropriate gifts for Mother’s Day, that while mothers around the world all love their children — not all of them have equal ability to ensure a child’s well-being.